I’m sorry I was your last memory before dying

I’m sorry.

I really am.  No one deserves breast cancer.  Especially the kind that spreads to your liver, lungs and brain.  The fact that you lived to your eighth decade doesn’t detract from the sadness.  You deserve to live.  I can’t blame you for not being ready to go.

I apologize that our meeting was so abrupt.  I was consulted to see you in the nursing home to address various issues.  I swept in the door, and introduced myself to you and your daughter. I explained what the word “palliative” means, and why I was asked to see you.  Although I saw a full hospice consult in the hospital chart, you both stared at me blankly as if this was the first time you heard of such things.

I asked if you were in pain.  I asked about your breathing as I watched your chest move back and forth laboriously, and your dreadfully weak body sink into the gigantic hospital bed.  Finally, I tried to discuss prognosis.

You mentioned how your oncologist said that “we can get it all.”  You placed great hope in the upcoming brain radiation.  When I pushed further, you had vague ideas about seeing your grandson’s wedding that was slated for next fall.

Your skin sallow, your breath heavy, there was absolutely no way you were going to be alive for that wedding.   I had doubts about the weekend.  When I started to express my concerns that your expectations were unrealistic, the conversation turned.  Your daughter shook her head and her glance shot arrows through my chest.  You became angry and shooed me out of the room.  I was asked not to return.

I thought of a million ways I could have done better.  I should have approached the situation differently.  I could have brought these subjects up over many visits and allowed you to come to conclusions on your own.

But for some reason, I felt a great sense of urgency.  Rounding the next morning in the nursing home, I found your bed empty.  You coded an hour after I saw you.  The ambulance came, life support was initiated, and now you lie half dead in the local ICU.  Your daughter is left to make the horrible decision of when to pull the plug, if ever at all.  You will not recover.

Some may think that I write this post to gloat; to say I told you so.  The truth is agonizingly more complex.  I wish I could do this one over.  I wish I could have left you in your mist of denial, and taken a more simple approach.  I could have held your hand, said I was sorry, and let sleeping dogs lie.  Your weren’t going to listen to me anyway.

Now, I am stuck with the great possibility that your daughter will see my visit as the straw that broke the camel’s back.  And you, your last memory before dying, will be of some young pompous doctor who walked into the room, and told you he was giving up on you.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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